Week 10 - Chapter 33 Drugs for Bipolar Disorder Flashcards
Bipolar Disorder
- -Formerly known as manic-depressive illness
- -Afflicts an estimated 3.7% of the adult population
- -Mainstays of therapy are lithium and valproic acid
- -Many patients also receive an antipsychotic
- -Chronic condition that requires lifelong treatment
- -Cause may be disruption of neuronal growth and survival
Bipolar Disorder
Definition and treatment
- -Definition of bipolar disorder (BPD)
- Cyclic disorder
- Recurrent fluctuations in mood
- Episodes of mania and depression persist for months without treatment
- -Treatment
- Drugs
- Psychotherapy
Bipolar Disorder
Types of drugs employed
- Mood stabilizers: Lithium, divalproex sodium, and carbamazepine
- -Relieve symptoms during manic and depressive episodes
- -Prevent recurrence of manic and depressive episodes
- -Do not worsen symptoms of mania or depression; do not accelerate the rate of cycling - Antipsychotics
- -Given during severe manic episodes - Antidepressants
- -Given during depressive episodes
Hypomanic Episode (Hypomania).
Hypomania can be viewed as a mild form of mania. As in mania, mood is persistently elevated, expansive, or irritable. However, symptoms are not severe enough to cause marked impairment in social or occupational functioning, or to require hospitalization. Psychotic symptoms are absent.
Major Depressive Episode (Depression).
A major depressive episode is characterized by depressed mood and loss of pleasure or interest in all or nearly all of one’s usual activities and pastimes. Associated symptoms include disruption of sleeping and eating patterns; difficulty concentrating; feelings of guilt, worthlessness, and helplessness; and thoughts of death and suicide. The characteristics of major depression are discussed further in Chapter 32.
Mixed Episode.
In a true mixed episode, patients experience symptoms of mania and depression simultaneously. Patients may be agitated and irritable (as in mania), but may also feel worthless and depressed. The combination of high energy and depression puts them at significant risk of suicide.
Pure Manic Episode (Euphoric Mania).
Manic episodes are characterized by persistently heightened, expansive, or irritable mood—typically associated with hyperactivity, excessive enthusiasm, and flight of ideas. Manic individuals display overactivity at work and at play and have a reduced need for sleep. Mania produces excessive sociability and talkativeness. Extreme self-confidence, grandiose ideas, and delusions of self-importance are common. Manic individuals often indulge in high-risk activities (eg, questionable business deals, reckless driving, gambling, sexual indiscretions), giving no forethought to the consequences. In severe cases, symptoms may resemble those of paranoid schizophrenia (hallucinations, delusions, bizarre behavior).
Lithium [Lithonate, Lithotabs]
A. Chemistry
B. Mechanism of action: Unknown
C. Therapeutic uses
D. LOW THERAPEUTIC INDEX!
A. Chemistry
- -Simple inorganic ion
- -Found naturally in animal tissues
B. Mechanism of action: Unknown
C. Therapeutic uses
- -BPD
- -Other uses: Alcoholism, Bulimia, Schizophrenia,
- -Glucocorticoid-induced psychosis
D. LOW THERAPEUTIC INDEX!
- -Excretion
- Short half-life, Excreted by the kidneys
- Sodium levels: Lithium excretion reduced when sodium level low
- -Plasma levels must be monitored
Lithium [Lithonate, Lithotabs]
Adverse effects
- -Excessive lithium levels
- Greater than 1.5 mEq/L
- Monitor levels every 2 to 3 days at initiation of therapy and then every 3 to 6 months
- -Therapeutic lithium levels
- Gastrointestinal effects
- Tremors
- Polyuria
- Renal toxicity
- Goiter and hypothyroidism
- Teratogenesis
Carbamazepine
It’s a type of antiepileptic drug.
- -Reduces symptoms
- -Protects against recurrence of mania and depression
Divalproex Sodium (Valproate)
It’s a type of antiepileptic drug.
–Valproate can control symptoms in acute manic episodes and can help prevent relapse into mania. However, the drug is less effective at treatment and prevention of depressive episodes.
